Population, Health, and Disease

The issue of population was as difficult in the early twenty-first century as it had been in the 1930s. Nations with less-developed economies struggled with the pressing problem of surging population, while Europe experienced more deaths than births after 1995. The less industrially developed countries accounted for 98 percent of worldwide population growth, in part because the spread of Western medicine enabled people there to live much longer than before. By 2015, the earth’s population had reached 7.25 billion, with a doubling forecast for 2045. (See “Taking Measure: World Population Growth, 1950–2015.”) Yet many European countries were facing problems related to an aging citizenry and a shortage of younger people to bring new ideas and promote change. In fact, Europe as a region had the lowest fertility in the world. The fertility rate in Italy and Spain was only 1.3 children per woman of reproductive age, far below the replacement level of 2.1 needed to maintain a steady population number. As a consequence, fewer young workers paid into the social security system to fund retirees’ pensions and health care.

Population problems were especially urgent in Russia, where life expectancy was declining at a catastrophic rate from a peak of seventy years for Russian men in the mid-1970s to fifty-one years at the beginning of the twenty-first century. Heart disease and cancer were the leading causes of male death, and these stark death rates were generally attributed to increased drinking, smoking, drug use, poor diet, and general stress. Between 1992 and 2014, the Russian population declined from 149 to 142 million. Meanwhile, fertility rates throughout the former Soviet bloc were also declining: the lowest levels of fertility in 2003 were in the Czech Republic and Ukraine (1.1 children per woman of reproductive age), and children in eastern Europe lived on average twelve years less than their counterparts in western Europe.

Good health was spread unevenly around the world. Western medicine brought the less-developed world increased use of vaccines and drugs for diseases such as malaria and smallpox. However, half of all Africans lacked the basic requirements of well-being such as safe drinking water. Drought and poverty, along with the corruption of politicians in some cases, spread famine in Sudan, Somalia, Ethiopia, and elsewhere. Around the world, the poor and the unemployed suffered more chronic illnesses than those who were better off, but they received less care. Whereas in many parts of the world people still died from malnutrition and infectious diseases, in the West noncontagious illnesses (heart disease, stroke, cancer, chronic obstructive pulmonary disease, autoimmune diseases, and depression) were more lethal.

Disease, like population and technology, operated on a global terrain. In the early 1980s, both Western values and Western technological expertise were challenged by the spread of a global epidemic disease: acquired immunodeficiency syndrome (AIDS). An incurable, highly virulent killer that effectively shuts down the body’s entire immune system, AIDS initially afflicted heterosexuals in central Africa; the disease later turned up in Haitian immigrants to the United States and in homosexual men worldwide. Within a decade, AIDS became a global epidemic. The disease spread especially quickly and widely among the heterosexual populations of Africa and Asia, passed mainly by men to and through women, but in 2010 the U.S. capital, Washington, D.C., had a rate of infection as high as that in Africa. Protease-inhibiting drugs helped alleviate the symptoms, but treatment was often not provided to poor people living in sub-Saharan Africa and the slums of Asian cities. In addition to the AIDS pandemic, the deadly Ebola virus, severe acute respiratory syndrome (SARS), swine flu, and dozens of other viruses smoldered like so many global plagues in the making. Diseases such as Ebola and the global fears they provoked along with environmental dangers underscored the interconnectedness of the world’s peoples.